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Culturally Sensitive Medical Professionalism

Dr. Ho is assistant dean for international affairs and associate professor, Department of Social Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; e-mail: mjho@ntu.edu.tw.

Medical professionalism is a core competency mandated by medical education accreditation agencies and professional organizations in the United States. With globalization, this emphasis on medical professionalism subsequently has spread to other parts of the world. Yet, as medical educators, we must consider whether medical professionalism, as defined in the West, can be transplanted to other cultural contexts without complications or rejections.

In April 2012, more than 1,000 medical educators from the Persian Gulf region and 30 international guest speakers gathered in the Kingdom of Saudi Arabia (KSA) to exchange ideas and share their experiences in medical education. As a medically qualified anthropologist trained in the West who teaches in East Asia, I facilitated a workshop focused on culturally sensitive medical professionalism. We reviewed the Physician Charter, the famous Western framework for medical professionalism endorsed by professional organizations around the world. We discussed whether the principles and responsibilities outlined in the charter also could be applied in the KSA. The 20 or so workshop participants from the Gulf region debated heatedly the principle of patient autonomy and a physician’s responsibility to patient confidentiality.

Seven years earlier, women in the KSA legally had been granted the right of consent. That it was not yet common practice came out during our discussion. The female participants, sitting in seats reserved for women, dressed in black abayas, many with masks covering their faces up to the eyes, made the point that the principle of patient autonomy did not apply to them because medical providers had to obtain consent from female patients’ Wali Amr or male guardian (a husband, father, brother, or son). Some of the male participants, sitting on the other side of the room, disagreed. They insisted that their society actually pays “special respect” to women, and they assured me that women in the KSA were “treated like queens,” that they were chauffeured and guarded everywhere they went.

Daily life in the KSA centers on communal prayers and patriarchal families. These social structures permeate medical practices as well. For instance, Saudi doctors share information with the male head of the patient’s family instead of the patient, often without the patient’s approval, an approach to patient confidentiality that differs from that in the West. A UK-trained physician added to the discussion that she felt that the KSA’s practice had some advantages, citing the difficulty she had with the Gillick competence, which advocates physicians seeking consent from minors in the UK. She shared that she felt sorry for minors who were left to face challenging issues such as abortion and self-harm alone and that she missed the strong family support in her native country. A Saudi medical student warned, however, that if patient confidentiality is not protected, some issues, such as premarital sex, might end with “honor killings” to protect the family’s name.

Today, patients, medical students, physicians, and medical educators frequently travel across national borders. I am confident that I share the hope of many medical educators that globalization will improve the quality of medical education and patient care worldwide. However, my experience in the KSA has made me think about the role that medical education framed with a Western perspective should play in different cultural contexts. I began to ponder how to support indigenous efforts in non-Western countries to ensure that the perspectives of those most affected by the divergences in medical norms, such as women and minors, remain part of the discussion on medical professionalism. I made myself a promise to listen to the full spectrum of voices and contemplate the consequences of future global exchanges, both celebrated and unwanted, in medical education at home and abroad.

Author’s Note: The author would like to thank the workshop participants and Jessie Norris for her editorial assistance.